Provider Demographics
NPI:1275535171
Name:CANCILLERI, JAMES A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:CANCILLERI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2547
Mailing Address - Country:US
Mailing Address - Phone:609-272-0655
Mailing Address - Fax:609-272-9317
Practice Address - Street 1:1601 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1877
Practice Address - Country:US
Practice Address - Phone:609-241-8664
Practice Address - Fax:609-415-2323
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001971NJ213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU01911Medicare UPIN
NJ3502802Q6WMedicare PIN
NJ624820Medicare ID - Type Unspecified